KINGDOM CLEAN SERVICE REQUEST FORM

KINGDOM CLEAN SERVICE REQUEST FORM
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Name (If not a company, type RESIDENTIAL)
Phone Number

Area CodePhone Number
Extension
Email
example@example.com
Address where cleaning service is being completed if not the same as above:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
House/Property Dimensions (i.e. square footage)
How did you hear about us?
What size is your Driveway?
If not getting driveway cleaned select N/A
Commerical & Residential Service Request Select One or more

Other
Preferred Date and Time of Service

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/PM Option
Service Duration:
Recurring Duration
ATTN:

There is a non-refundable $50 deposit to secure your date of service.

Payment Options:

CASHAPP: KINGDOMSRV

ZELLE & PAYPAL: kingdomclean316@gmail.com

APPLEPAY: 773-499-6941

CREDIT OR DEBIT

CASH, CASHIERS CHECK, COMPANY CHECK OR MONEY ORDERS ACCEPTED

NOTE:

WE DO NOT ACCEPT PERSONAL CHECKS
Description/Instructions from Client (If none type N/A):
Please upload photos of area being serviced and you will receive your quote:

Browse Files

Cancelof
Signature
Should be Empty: